Insulin resistance – the basics every medical specialist should know

Introduction and purpose: Insulin resistance (IR) is a health problem as it can accompany obesity and lead to serious metabolic complications. In recent years, it has been "overdiagnosed" in clinical practice due to the lack of specific diagnostic criteria. The article summarizes the current knowledge in the field of pathophysiology, clinical picture and diagnostics. State of knowledge: Obesity remains the leading cause of IR, especially in the 21st century. In a positive energy balance, the adipocyte overloaded with fat protects itself against further influx of glucose and fats and becomes insulin insensitive. A component of IR development is subclinical inflammation of macrophage-rich adipose tissue which is exacerbated by an adipocytokine imbalance, which in turn generates IR. The markers of cellular resistance to insulin are free fatty acids in the bloodstream which are responsible for the lipotoxicity in hepatocytes and myocytes. Compensatory fasting hyperinsulinemia, which is currently considered the most sensitive diagnostic criterion, provides evidence of IR. An effective method of sensitizing cells to insulin is lifestyle modification, including a low-energy diet with regular physical activity in the form of aerobic-resistance exercise. Literature recommends no pharmacological treatment of IR alone, without obesity or other concomitant diseases. Conclusions: IR is not a separate disease, but only a pathological expression of cells' adaptation to excess of consumed energy. However, in its systemic form, when the protective mechanisms become ineffective, it induces metabolic disturbances. Only the causal treatment of IR guarantees therapeutic success

Is water fluoridation correlated with hypothyroidism?

Introduction: Hypothyroidism is a global health problem. Primary thyroid hormone deficiency may be caused by a wide spectrum of health problems, e.g. chronic autoimmune thyroiditis, postpartum thyroiditis, iodine deficiency, thyroid or parathyroid surgery and drugs. In recent years, scientific studies have also been published indicating a correlation between excessive intake of fluoride and hypothyroidism. Fluoride is added to the water sources of many countries. Objective: The purpose of the study was to review and compare currently available data on PubMed about fluoride-induced hypothyroidism. A brief description of the state of knowledge: Evidence based knowledge suggests that there is a potential relationship between water fluoridation and endocrine system disorders, especially hypothyroidism. Current studies indicate that TSH hormone levels get elevated with increased fluoride intake. The reason is supposed to be that fluorine is more electronegative than iodine and therefore easily displaces iodine from the body, thus affecting thyroid function. Conclusions: Current studies do not clearly show a simple correlation between excessive fluoridation of drinking water and the occurrence of hypothyroidism. However, inconclusive scientific evidence and the prevalence of hypothyroidism in the population indicate the need for further research in this area

Application of botulinum toxin in the treatment of bruxism

Bruxism is a commonly reported functional para-function of the oral cavity. Its symptoms are quite characteristic and include, above all, excessive clenching and grinding of the teeth. (2) Other complaints most frequently reported by patients are headaches, pain in the temporomandibular joint, excessive tooth abrasion, damage to dentures, waking up at night, visual effect - the so-called "square jaw". The etiology is multifactorial therefore it is difficult to treat its symptoms.  Botulinum toxin is a neurotoxin produced by the anaerobic bacteria Clostridium botulinum. Its mechanism is based on the reversible inhibition of acetylcholine release in neuromuscular junctions. Intramuscular injection of botulinum toxin is one of the treatments of bruxism. So far, this method is used off-label. Looking at the promising results of randomized studies on the use of botulinum toxin in bruxism, this may change in the near future. As shown by previous studies, it is not an ideal method, but nevertheless it is one of the most effective and the best for the patient. The downside to the use of botulinum toxin in the treatment of bruxism symptoms are, inter alia, contraindications to the use of this drug and the duration of its action - 3-6 months. This systematic review of selected articles and studies aims to examine the available literature in order to determine the effectiveness of the use of botulinum toxin in the treatment of bruxism and to assess whether it is currently the most effective method.  Pubmed and Google Scholar were searched for literature

Monkeypox - new epidemiological threat? Review of the current literature

The mokeypox is zoonotic disease caused by an orthopoxvirus, which was first isolated and identified in 1959 among captive monkeys transported to Copenhagen, Denmark from Africa for research purposes. Monkeypox in humans was initially diagnosed in 1970 in the Democratic Republic of the Congo and then it has spread to other regions of Africa. The monkeypox cases in Africa were neglected by the scientific community for past decades till 2022, when thousands of cases were reported  from nonendemic countries around Europe and in the western hemisphere. Therefore monkeypox has recently been labelled as a public health emergency of international concern by the WHO. Monkeypox virus is believed to have several modes of transmission, all of which are associated with direct or indirect contact with infected animals or infected humans. The diagnosis of monkeypox infection is based on the history, clinical symptoms and laboratory tests such as PCR.The illness begins with nonspecific symptoms such as fever, lethargy, lymphadenopathy, myalgias and then it occures the rash first on the face and then across the body which lasts for 2–4 weeks. Most cases of monkeypox are mild and self-limited disease, which require only supportive treatments. However in very severe cases antiviral medications such as tecovirimat may be administered.  Smallpox vaccination has been estimated to provide 85% cross-protection against monkeypox infection. The main problem is there is a huge population born only after the discontinuation of the smallpox vaccination campaign with  lack of cross-protective immunity. The question is - the monkeypox is only old neglected foe or a new epidemiological threat

PIMS - symptoms and short/long-term gastrointestinal and cardiovascular system complications

PIMS (paediatric inflammatory multisystem syndrome associated with COVID-19 or Multisystem Inflammatory Syndrome in Children (MIS-C)) is a new disease classification, occurring in children and young adults associated with the SARS-CoV-2 infection. Although children suffer from COVID-19 infection asymptomatically or mildly, long-term complications of the disease may be more severe for them than for adults. Despite the fact that PIMS is a relatively new disease, we already know that it should not be underestimated. In spite of the clinical picture of these complications may resemble Kawasaki Disease (KD), we may notice some differences in laboratory tests (such as reduced number of lymphocytes, decreased platelet count or elevated ferritin levels). Although usually the first symptom of PIMS is high fever, it is followed by symptoms related to the digestive system, present in about 80% of cases. The insidious and severe gastrointestinal symptoms of PIMS can mimic abdominal surgical emergencies, including acute appendicitis, gastrointestinal infections or inflammatory bowel disease. Cardiovascular symptoms occur in approximately 60% of patients with PIMS. Immunomodulatory therapy plays an essential role in the treatment of PIMS. The exact causes of PIMS are recently unknown, however, it is explained as genetic hyperactivation of immunity. In this minireview we summarize the most recent data about this condition, mainly we are focusing on gastrointestinal and cardiovascular  symptoms, short/long-term complications and treatment

Takotsubo cardiomyopathy – review of current literature

Takotsubo syndrome (TTS) also known as broken heart syndrome is acute cardiac disease, which is characterized by reversible ventricular motion abnormalities, in the absence of justifying coronary artery disease. The clinical entity was first described in Japan in 1991. The word “Takotsubo” is a container used by the Japanese to catch octopus, which has a narrow neck and a relatively wide base, which resembles the heart's shape in TTS. The cardiomiopathy predominantly affects postmenopausal women and is often preceded by emotional (death of close family member, domestic abuse) or physical (external injury, severe pain) stress. The exact pathophysiological mechanism has not yet been fully clarified. Inordinate amount of catecholamines released into bloodstream after stress attack plays a crucial role in the pathogenesis of TTS. Symptoms of Takotsubo cardiomyopathy such as chest pain and dyspnea are similar to acute myocardial infarction due to it TTS requires careful diagnosis. The main tools for making diagnosis are echocardiography, coronary angiography, ECG, cardiac biomarkers and cardiac magnetic resonance. The syndrome is usually reversible, nevertheless number of patients may develop complications such as cardiogenic shock, arrhythmias, heart failure. Treatment is mostly supportive including Angiotensin-converting enzyme (ACEi) inhibitors and angiotensin receptor blockers (ARBs), which may reduce the likelihood of recurrent episodes. Generally patients with TSS have favourable prognosis, although some deaths are reported. This article is a review of current medical knowledge about Takotsubo syndrome based on available publications in Pubmed and Google Scholar databases

Sexual activity in terms of cardiac rehabilitation after cardiovascular incidents

Cardiovascular diseases (CVD) are still the leading cause of death. Environmental factors such as smoking, low physical activity and poor diet have the greatest impact on the incidence of the disease. For patients after a cardiovascular incident, cardiac rehabilitation is the key to recovery. One possible path of rehabilitation is sexual activity (SA). Sexual activities are similar to mild/moderate physical activity during a short period. Most patients are recommended to involve in sexual activity after prior comprehensive evaluation of physical condition. Before involving in sexual activity the general condition of the patient needs to be checked.  A useful method for this is a stress testing. The patients with stable cardiac symptoms and good functional capacity are at a low risk of recurrent cardiovascular events, and others require treatment or improvement of heart function. The most efficient way to provide SA is a sexual counseling. Evidence suggests that relatively few cardiac patients receive sexual counseling, which can result in negative outcomes ranging from psychological, physical, and quality of life. Sexual problems and concerns are prevalent, including patient and partner fear of causing another heart attack. It is because people still believe that sexual activity is too risky and they cease all of it. Sexual counseling is needed across health care settings to ensure that patients receive information to safely resume SA

The diagnosis of periprosthetic joint infection after the arthroplasty of knee joint

Total knee replacement is one of the most widely performed surgeries. It is stated as the most efficient method of treating end-stage osteoarthritis of the knee joint.  Due to the aging of the population and the prevalence of osteoarthritis, the number of arthroplasties is increasing every day.  Such extensive surgical procedures are associated with a large number of postoperative complications, one of which is periprosthetic joint infection. The reported prevalence of PJI out to 2 years after knee replacement is 1.55 %. Misconceptions in the management of periprosthetic joint infection (PJI) can compromise the treatment success. The aim of the following article was to provide an overview of the medical knowledge on the periprosthetic joint infection after the arthroplasty of knee joint. Infections are caused by microbes that can enter the joint, which are most often coagulase-negative Staphylococci, Staphylococcus Aureus, Streptococci, Enterococci and Gram-negative bacteria. Fungal infections are much less common. The diagnostic process requires the involvement of a large group of medical personnel, which is why protocols with algorithms have been created to facilitate and standardize the diagnosis in the direction of periprosthetic joint infections. Mainly used tests from the patient's serum, synovial tests and histology. The positive results of the above tests are taken into account in the assessment of the fulfillment of the major and minor criteria to assess the likelihood of the occurrence of periprosthetic infection. This research paper aims to analyze the latest medical reports on the PJI diagnostic algorithm, laboratory and imaging studies of their effectiveness. This article was written based on analyzing data available in publications in Pubmed and Google Scholar database

Selenium and Hashimoto disease

       Selenium is one of the most important micronutrients affecting the human body. It plays a crucial role in the thyroid gland, where its concentration is the highest. This element has the ability to remove reactive oxygen species and deiodinate thyroid hormones. Balanced diet and supplements are basic for achieving proper concentration of selenium in human organism. Recently a number of studies have been conducted focusing on the effect of selenium on autoimmune thyroiditis - Hashimoto’s disease. In our study the oral supply of selenium was used, and then the levels of selected parameters were measured. It has been proved that Selenium lowers levels of antithyroglobulin and anti-thyroid peroxidase antibodies. Moreover the concentration of Thyroid Stimulating Hormone is also lowered by this micronutrient. In this review we draw attention to possible resources of delivery of this element to organisms and the impact it has on the course of the above-mentioned diseases. We come to conclusion that there is a strong correlation between Selenium and the functioning of thyroid gland. Doctor’s awareness and cooperation with the patient in order to establish proper doses of micro- and macronutrients which are taken with basic medications is very important for the therapeutic process. This article is a review of current medical knowledge about Selenium affecting a thyroid gland based on available publications in Pubmed and Google Scholar databases

Skin cancer’s prevention in the light of current medical knowledge

Among all diagnosed malignancies, skin cancers account for more than 30-50%. Caucasian patients have a lifetime risk of more than 20%. The incidence increases with the age of patients. In 2017, there were over 14,000 new cases in Poland. It can be expected that these results are underestimated due to incomplete registration of new cases in the National Cancer Registry.(1,2)The most common skin cancer is basal cell carcinoma - over 80% of cases. In second place is squamous cell carcinoma - 15-20%. Other types are less common.(1)The appearance of a new mole or a change in the appearance of an existing one is often missed at the beginning, and even if it is noticed, it is underestimated by the patient. Therefore, detection rate of skin cancer, including melanoma at an early stage, is unfortunately relatively low.The incidence of skin cancer is constantly increasing, which is an important epidemiological problem of modern medicine.(2)Patient education should focus on behaviors that the patient can influence and modify, including: regular visits to a dermatologist and undergoing a dermatoscopic examination, the use of sunscreen with a high UV factor, the use of special protective clothing, sunglasses, covering head when under sun’s exposure, moderate overall sun exposure, avoiding sunburn, not using a tanning bed.The purpose of this review was to assess the current literature on the impact of educating the public and promoting sun protection as a necessary method to directly reduce the incidence of skin cancer.The literature was searched in Pubmed and Google Scholar databases